Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study

This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 19 degrees, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.

Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study

This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 19 degrees, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.

The art and science of a behavioural approach to care

Behavioural psychology has much to offer residents, families and staff. Properly developed, a behavioural approach to care is at once humane, scientific and practical. In our experience, the dedication of resources and expertise to implementation of a behavioural approach to care has been truly beneficial for all concerned.

High functioning autism and Childhood Disintegrative Disorder in half brothers

Childhood Disintegrative Disorder (CDD) is grouped with autism as a subtype of Pervasive Developmental Disorder (PDD) in ICD-10 and DSM-IV. This is the first report of autism and CDD cosegregating within a sibship. J. P. and M. P. are half-brothers with the same mother. J. P. is an 18-year-old with impairments in communication, social reciprocity, and stereotypies and was diagnosed with autism. M. P. is a 7-year-old who developed normally to 2 years 4 months. He then underwent a profound regression, becoming nonverbal and socially withdrawn, and lost adaptive skills. Investigations did not reveal any neurodegenerative process. M. P. was diagnosed with CDD. The rarity of the two conditions suggests a shared transmissible mechanism. The implications for autism/PDD genetic studies are discussed.

The published DNA sequence of human cytomegalovirus strain AD169 lacks 929 base pairs affecting genes UL42 and UL43

Compared with the published DNA sequence (M. S. Chee, et al. Curr. Top. Microbiol. Immunol. 154:125-170, 1990), most isolates of human cytomegalovirus strain AD169 contain an additional 929 bp after nucleotide 54612. This results in a changed reading frame for the 5'-terminal 50 codons of gene UL42 and expansion of gene UL43 (a US22 family member) from 187 (3'-truncated) to 423 (full-length) codons. The UL42 and UL43 gene products are nonessential for growth in culture.

Pulmonary response to inhaled antigen: neuroimmune interactions promote the recruitment of dendritic cells to the lung and the cellular immune response to inhaled antigen

Dendritic cells (DCs) play a critical role in capturing and presenting inhaled antigens to T lymphocytes. We report that pulmonary DCs in the Lewis rat are normally located in the lung in immediate proximity to nerve fibers that contain immunoreactive substance P (SP). Functionally, pulmonary DCs bound 125I-SP and displayed increased motility in vitro in response to graded concentrations of SP. However, SP had no effect on the accessory cell activities of DCs. To examine the role of neural influences on the pulmonary immune response to inhaled antigen, Lewis rats were pretreated with capsaicin (CAP), which damages small nerves and depletes neuropeptide stores, and then challenged intratracheally (i.t.) with hen egg lysozyme (HEL). The number and antigen-presenting cell activities of pulmonary DCs in the CAP-treated rats were comparable to those of controls up to day 14. T lymphocytes harvested from the regional lymph nodes draining the lung were effectively sensitized to HEL in both groups. However, when CAP-treated rats sensitized to HEL i.t. at day 0 were rechallenged with HEL i.t. at day 14, the lungs showed decreased numbers of OX-6+ DCs and diminished pulmonary lymphoid infiltrates compared with controls. We suggest that CAP interferes with a neural-mediated response that contributes to the accumulation of inflammatory cells during the efferent limb of the pulmonary-cell-mediated immune response in vivo.

Determination of the true metabolizable energy (TMEN) by roosters of feedstuffs made from seal by-products

TMEN values for various seal by-product feedstuffs were determined using roosters. Four samples of seal meal [seal meal 1991, seal meal 1992, seal meal 1994 (juveniles), seal meal 1994 (mixed ages)] and three samples of seal meat (oven-dried at 50 °C, oven-dried at 120 °C, and freeze-dried) were given to 16 roosters (30 g: precision fed) housed in individual wire cages. Total collection of excreta from a 48-h period was used to provide samples for analysis of gross energy, nitrogen, and dry matter content. TMEN results indicate variability in quality of the meals, associated with the different raw materials used to produce the seal meals as well as year of production. The TMEN values for the seal meals ranged from 3896 kcal kg−1 to 4621 kcal kg−1 with an average value of 4283 kcal kg−1. The crude protein content of the seal meals ranged from 64.2 to 67.6%, the crude fat content from 12.7 to 14.7%, the calcium content from 5.38 to 8.98% and the total phosphorus content from 3.16 to 4.79%. Oven-drying the seal meat at 120 °C significantly reduced TMEN (2643 kcal kg–1). The TMEN values for the freeze-dried and the low temperature oven-dried (50 °C) seal meat were not significantly different (4008 kcal kg–1 and 4013 kcal kg–1, respectively). Key words: True metabolizable energy, seal by-products, roosters, seal meal, seal meat, TMEN

High phenotypic correlations among siblings with autism and pervasive developmental disorders

The objective of this study was to examine familial factors influencing clinical variation in sibships that contained at least 2 children affected with autism or another form of pervasive developmental disorder (PDD). The sample included a total of 60 families, 23 with multiple cases of PDD and 37 with a single affected child. Measurements of IQ, adaptive behaviors in socialization and communication, and autistic symptoms were taken on all affected children. A high intraclass correlation, especially on IQ and an index of social behaviors, was observed between affected children from the same family. In contrast, low correlations were observed on measurements of IQ and adaptive behavior between affected and unaffected children from the same family. These data indicate that variation in severity of PDD is influenced by familial, and probably genetic, mechanisms. The results are discussed in relation to current theories on the genetics of autism and the heritable mechanisms underlying variations in clinical severity.

Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in allergic bronchopulmonary aspergillosis

The etiology of allergic bronchopulmonary aspergillosis (ABPA) is not well understood. A clinical phenotype resembling the pulmonary disease seen in cystic fibrosis (CF) patients can occur in some individuals with ABPA. Reports of familial occurrence of ABPA and increased incidence in CF patients suggest a possible genetic basis for the disease. To test this possibility, the entire coding region of the cystic fibrosis transmembrane regulator (CFTR) gene was analyzed in 11 individuals who met strict criteria for the diagnosis of ABPA and had normal sweat electrolytes (< or = 40 mmol/liter). One patient carried two CF mutations (deltaF508/R347H), and five were found to carry one CF mutation (four deltaF508; one R117H). The frequency of the deltaF508 mutation in patients with ABPA was significantly higher than in 53 Caucasian patients with chronic bronchitis (P < .0003) and the general population (P < .003). These results suggest that CFTR plays an etiologic role in a subset of ABPA patients.

Effect of 2-row or 6-row barley and a commercial enzyme preparation on growing-finishing broiler chickens from 3 to 6 weeks of age

A study was conducted to determine the efficacy of barley-based diets with or without a crude enzyme preparation for male broiler chickens from 3 to 6 wk of age. Treatments consisted of feeding grower and finisher diets based on two locally grown cultivars of barley, 2-row (unspecified cultivar) and 6-row (Leger) added at 0, 20, 40 and 60%, with 0 or 1000 mg commercial enzyme preparation/kg diet. The starter diet contained no barley. Enzyme addition to the 2-row barley-based diets resulted in significantly heavier 6 wk body weights compared to the non-supplemented diets and significantly improved feed efficiencies during the 5- to 6-wk period indicating an enzyme response in older birds. Level of 2-row barley did not have significant main effects on 6 wk body weight, weight gain, feed consumption, feed efficiency, mortality, or live grade, except for leg abnormalities. A significant linear contrast revealed increased percentage of leg abnormalities as the level of barley in the diet increased. Significant interactions were found between level of 2-row barley and enzyme addition for feed consumption and feed efficiency from 3 to 5 wk of age. Significant quadratic contrasts for level of barley within non-supplemented treatments indicated lower feed consumption of the 20 and 40% barley-fed birds than the 0 and 60% barley-fed birds during the 3-to 5-wk period. During the 5- to 6-wk period, feed consumption of the enzyme-supplemented diets increased linearly with percentage of barley in the ration. Neither level of 6-row barley nor enzyme addition to the 6-row barley diets had significant main effects on 6 wk body weight, weight gain, feed consumption, feed efficiency, or live grade. Significant interactions were found between level of 6-row barley and enzyme addition for 6 wk body weight, 3–6 wk weight gain and feed consumption for the 5–6 wk period. A significant quadratic contrast for level of barley within non-supplemented treatments revealed lower feed consumption of the 20 and 40% barley-fed birds compared to the 0 and 60% barley-fed birds during the 5–6 wk period. Thus, for the diets without glucanase, there was an effect of barley percentage which became apparent at different ages depending on the barley cultivar. As with the 2-row barley diets, there was a significant linear increase in feed consumption of the enzyme-supplemented diets as the level of 6-row barley in the diet increased during the 5–6 wk period. It appears from the results that the grower and finisher diets could contain up to 60% barley without being detrimental to growth but incidence of mortality or leg abnormality may increase somewhat. Enzyme addition improved feed efficiency for the 2-row barley diets, and erased the quadratic effects of barley level apparent when diets did not include β-glucanase. Key words: Barley, broiler chicken, enzyme, growth

Naked oats in grower and finisher diets for male chicken roasters and female turkey broilers

Two experiments were conducted to evaluate naked oats as a feedstuff for male chicken roaster and female turkey broilers. In exp. 1, grower and finisher roaster diets were formulated to contain 18, 36, 54, or 72% naked oats (Avena nuda L. 'Tibor'). The starter diet contained no naked oats. Two trials were conducted utilizing 1344 birds. Treatment diets were fed to four pens of roasters each, from 21 to 64 d of age. In exp. 2, grower and finisher turkey diets were formulated to contain 0, 22, 44, or 66% naked oats. The starter diet contained no naked oats. Two trials involving 964 birds were conducted. Treatment diets were fed to four pens of turkeys each, beginning at 21 d of age. Level of naked oats did not affect weight gain, feed efficiency or mortality of the roasters. The turkey poults consuming the 66% naked oats diet had significantly heavier 10-wk body weights and greater weight gains from 3 to 10 wk of age than those fed the other diets. In Trial 1, treatment had no significant effect on weight gains or feed efficiency for the finishing period (10–16 wk). In Trial 2, birds fed the 66% naked oats diet consumed significantly less feed than those fed the other diets, and had significantly heavier 12-wk body weights than birds fed the 22 and 44% naked oats diets. Treatment had no significant effect on weight gain or feed efficiency for the finishing period (10–12 wk). It appears that naked oats were a suitable feedstuff for the birds in this study. Key words: Naked oats, chicken roaster, turkey broiler, growth

Comparison of serum free thyroxine measurements by chemiluminescence and equilibrium dialysis

A study of 239 patients compared free thyroxine (FT4) measurements made by equilibrium dialysis (ED) with measurements made using the Magic Lite FT4 chemiluminescence (CI) immunoassay (Ciba Corning Immunodiagnostics). Patient groups: 41 normals; 27 hyperthyroid; 29 hypothyroid; 37 sick euthyroid; 10 chronic renal failure (CRF) and 25 pregnant patients; 13 oestrogen; 10 heparin; 12 salicylate; and 9 dilantin-treated patients; 3 lipaemic; 5 haemolysed; 6 hyperbilirubinaemic patients; 6 low thyroid binding protein (TBP) and 6 high TBP level patients. The two assays gave comparable results in most groups. Both assays tended to give elevated values in heparinized patients but FT4-ED results were more obviously affected. Pregnant patients and women on oral oestrogen had higher mean values with FT4-ED. In both assays the sick euthyroid and CRF patients had mean FT4 values similar to healthy euthyroid patients; the range of values in sick euthyroid and CRF patients was similar in both assays but wider than in healthy euthyroid patients. A supplemental study of 81 unselected acutely ill patients using FT4-Cl alone confirmed the wider range of values to be anticipated in sick euthyroid patients.

Introductory course in medical English and primary care for overseas doctors

This paper reports on a unique collaboration between two departments in the University of Edinburgh to develop and assess the value of a combined course in medical English and primary care, appropriate for young doctors from overseas who have a career intention in primary care.

Ocular neuromyotonia. A clinical description of six patients

We report the cases of six patients with ocular neuromyotonia, a disorder believed to result from episodic involuntary discharge of ocular motor nerves producing sustained and inappropriate contraction of their respective ocular muscles. Transient disturbances of ocular motility and diplopia result. Four patients had involvement of ocular muscles supplied by the third cranial nerve: one had presumed involvement of the superior oblique muscle, and one the lateral rectus muscle, suggesting abnormal discharge in the fourth and sixth cranial nerves, respectively. Four of six patients received prior radiation therapy for pituitary tumors, implying a possible pathogenic link. Three patients improved after treatment with membrane-stabilizing medication, suggesting that unstable membranes of injured ocular motor axons may generate spontaneous impulses, which produce involuntary sustained and inappropriate ocular muscle contraction.

Environmental control systems in chronic care hospitals and nursing homes

Fifteen severely disabled people residing in institutions were provided with a simple environmental control system which performed five different functions. The disabled people used the equipment an average of ten times a day. Two hours of nursing care by nursing staff would have been required to perform these functions. The cost of the equipment was $1.35 a day. Both the residents and the nursing staff reacted favorably to this innovation. The main benefits which resulted were a heightened sense of independence on the part of the disabled people and a reduction of frustration levels of both the residents and the nursing staff. A considerable savings in nursing care was also achieved.

A thyrotropin radioimmunoassay kit evaluated vs two reference assays

We evaluated a double-antibody radioimmunoassay kit for thyrotropin that includes calibrators prepared in a matrix of human serum and involves overnight nonequilibrium. Results were compared with those from two reference assays for thyrotropin. The range of within-assay CVs for the kit for thyrotropin values between 0.9 and 2.4 milli-int. units/L was 2.2 to 5.3%, that for between-assay CVs was 8.3 to 30%. The estimated minimum detectable concentration of thyrotropin was 0.6 milli-int. unit/L. We saw no cross reactivity with human choriogonadotropin by any of 48 sera from pregnant women. The original lot of serum specified as thyrotropin-free contained small but measurable amounts of thyrotropin; a second lot did not. Clinical data generated with the kit and the reference assays correlated well and were consistent with the clinical status of various categories of patients.

A thyrotropin radioimmunoassay kit evaluated vs two reference assays

We evaluated a double-antibody radioimmunoassay kit for thyrotropin that includes calibrators prepared in a matrix of human serum and involves overnight nonequilibrium. Results were compared with those from two reference assays for thyrotropin. The range of within-assay CVs for the kit for thyrotropin values between 0.9 and 2.4 milli-int. units/L was 2.2 to 5.3%, that for between-assay CVs was 8.3 to 30%. The estimated minimum detectable concentration of thyrotropin was 0.6 milli-int. unit/L. We saw no cross reactivity with human choriogonadotropin by any of 48 sera from pregnant women. The original lot of serum specified as thyrotropin-free contained small but measurable amounts of thyrotropin; a second lot did not. Clinical data generated with the kit and the reference assays correlated well and were consistent with the clinical status of various categories of patients.

Aspartate-taurine imbalance in dominantly inherited olivopontocerebellar atrophy

Amino acids were measured in autopsied brain from two patients who died with a dominantly inherited form of olivopontocerebellar atrophy. Neuropathologic changes found in the brain of these patients suggested a loss of cerebellar climbing fibers. The contents of aspartic acid, gamma-aminobutyric acid, and homocarnosine were reduced in the cerebellar cortex and the dentate nucleus, while taurine content was markedly elevated in the same brain regions. These findings are compatible with the possibility that aspartic acid is the excitatory synaptic transmitter of the climbing fibers and taurine is the inhibitory neurotransmitter of one or more types of interneurons in the cerebellum.

Cerebrospinal fluid and plasma glutamine elevation by anticonvulsant drugs: a potential diagnostic and therapeutic trap

Administration of phenobarbitone or primidone can produce an elevation of glutamine and ornithine concentrations, together with a reduction of urea concentrations, in the fasting plasma and CSF of some infants, and in the CSF of some older epileptic patients. These two anticonvulsant drugs may interfere with the metabolic conversion of ammonia to urea, possibly by enzyme inhibition at the step of carbomoyl phosphate synthesis. The elevation of glutamine in plasma and CSF can mimic values found in some hyperammonemias. Recognition of this drug reaction can prevent erroneous diagnoses of genetically-determined urea cycle disorders and subsequent inappropriate therapy.

Nonketotic hyperglycinemia. Glycine accumulation due to absence of glycerine cleavage in brain

Glycine concentrations were measured in plasma and cerebrospinal fluid of five patients in different types of hyperglycinemia to determine why severe neurologic deterioration is confined to the so-called nonketotic form of hyperglycinemia. Glycine content and glycine-cleavage enzyme activity were also determined in brain obtained in autopsy from three of these patients. Spinal-fluid glycine concentrations were 15 to 30 times above normal in patients with nonketotic hyperglycinemia, but were normal in those with hyperglycinemias of undetermined type who had comparable elevations of plasma glycine. Glycine content was two to four times above normal in several brain regions, and brain glycine cleavage enzyme activity was absent in two patients dying of nonketotic hyperglycinemia. By contrast, glycine content was normal and glycine cleavage activity present in the brain of an infant who died of hyperglycinemia of unknown cause. These results suggest that elevated glycine levels may be harmless in blood, but lethal in brain.